Provider Demographics
NPI:1710753223
Name:ADVANCED COMMUNITY OUTREACH CENTER
Entity Type:Organization
Organization Name:ADVANCED COMMUNITY OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-968-3442
Mailing Address - Street 1:1209 E DONEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1948
Mailing Address - Country:US
Mailing Address - Phone:407-968-3442
Mailing Address - Fax:
Practice Address - Street 1:3365 W VINE ST STE 207
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4665
Practice Address - Country:US
Practice Address - Phone:407-968-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management